Milk Production and Your High-Risk Baby

When milk production is delayed or not enough

A delay in the time when milk "comes in" sometimes occurs after the birth of a high-risk baby. Also, it is not unusual to experience a drop in the amount being pumped after several weeks. A drop may be gradual or it may occur suddenly.

Do not wait to get help if milk production is ever a concern. The sooner you intervene, the better. Ask a certified lactation consultant (IBCLC--International Board of Certified Lactation Consultants), your baby's nurse, doctor, or a breastfeeding support leader to help you figure out what might be affecting milk production if:

You are not producing a daily total of at least 16 ounces of milk by seven to 10 days postpartum.

You begin obtaining less and less milk each day for three or four consecutive days.

The daily total dips below 12 or 13 ounces for more than two or three consecutive days.

Possible causes for delayed or low milk production

Infrequent or insufficient breast pumping (milk removal) is the most common reason for a delay in the time when the milk "comes in," for insufficient milk production, or for any drop in milk production. A review of the number and length of pumping sessions should always be first thing you do if you are ever concerned about milk production.

It is easy to fall into the trap of letting more and more time pass between pumping sessions when recovering from birth and visiting the baby in the NICU. Also, a mother may initially obtain more milk quickly when several hours pass between pumping sessions. However, without frequent and effective milk removal, the breasts soon get the message to slow milk production. Within a day or two, a mother who pumps less and less often will start producing less milk.

Equipment checks

If your breast pumping routine does not seem to be the problem, it may be the breast pump you are using. Many mothers find that a hospital-grade, double electric pump works best when pumping for a high-risk infant. Some women find that manual (hand), battery-operated, or smaller electric breast pumps are not effective at establishing and maintaining a milk supply. Once you have obtained your pump, pay attention to how well it is working. If you suspect that the pump is not working properly, call the rental station or manufacturer.

Maternal factors for delayed or not enough milk production

A delay when milk "comes in." Occasionally, a mother has a health condition that may temporarily delay the large increase in milk production usually seen between three to five days postpartum. In these cases, large amounts of milk are not seen until seven to 14 days after giving birth. If this happens to you, do not feel discouraged. Keep pumping.It can be difficult to keep pumping at least eight times in 24 hours (for more than 100 total minutes) when getting only drops of milk with each session. However, it is extremely important to keep expressing milk frequently. This kind of delay does not mean a mother will have trouble producing enough milk once the milk does "come in." Usually, she has plenty of milk as long as she has been pumping (removing milk) often enough.Research has yet to discover whether the cause for a delay in increased milk production is due to a health-, pregnancy-, or birth-related condition; certain medical treatments for such conditions; or a delay in beginning frequent milk expression that often occurs with such conditions. Some conditions, or treatments, that experts think may possibly contribute to a delay for milk to "come in" include the following:

Stress

Cesarean (surgical) delivery

Postpartum hemorrhage

Maternal obesity

Infection or illness with fever

Diabetes (juvenile, adult-onset, or gestational)

Thyroid conditions

Strict or prolonged bed rest during pregnancy

Not enough milk. Rarely, a delay in the time when milk "comes in" turns into an ongoing problem of low milk production. A mother begins obtaining more milk but it still is not enough; or a mother may have been producing lots of milk, but the daily total amount of milk obtained is slowly, or quite suddenly, decreasing. Some of the conditions associated with a delay may also have an ongoing effect on milk production, including increased stress, severe postpartum hemorrhage, retained placental fragments, and thyroid conditions. If a mother had a breast surgery that cut some of the nerves, milk-making tissue, or milk ducts, she may have difficulty producing enough milk to fully feed her baby.Other factors can also lead to insufficient or low milk production. These include the following:

Maternal smoking

Some medications and herbal preparations

Hormonal forms of birth control, especially any containing estrogen. However, some mothers report a drop in milk production after taking a progestin-only contraceptive during the first four to eight weeks postpartum. Consult your doctor or obstetrician for more information.

If insufficient milk production seems to be a problem, yet you have been sticking with the recommended pumping routine and the pump is in good working order, consider the following:

Increase the frequency of milk expression to nine to 12 pumping sessions. You can also increase the time of each pumping session. Do this for several days.

Begin or increase the amount of skin-to-skin contact you have with your baby during visits to the NICU.

Ask your doctor or a certified lactation consultant (IBCLC) to review your health history with you to learn if there may be a health condition, treatment, or medication that is altering your milk production.

Ask your obstetrician or a certified lactation consultant (IBCLC) about medications or herbal preparations found to have a positive effect on milk production.

Think positive. Although insufficient milk production usually can be reversed, any milk you produce, even drops, is valuable for your baby. Try to remember that the milk collection bottle is half full rather than feel discouraged that it is half empty.

Overproduction of milk. Some mothers consistently obtain much more than 25 to 27 ounces in 24 hours. Their freezers are overflowing with containers of expressed breast milk. When mothers are making a lot more milk than even a full-term baby or twins could handle, some find they can drop one or two daily pumping sessions. It is important for these mothers to continue pumping for 100 minutes in 24 hours. These mothers can often achieve this in fewer sessions of pumping. If the daily amount pumped ever drops below 25 ounces (750 ml) for 24 hours, another pumping session should be added.Making too much milk is usually not a problem, so there is no reason to interfere with a successful plan for milk expression unless it is hard to maintain. If you are "overproducing" and considering changing your pumping routine, it is recommended that you:

Discuss your situation with a certified lactation consultant (IBCLC) or your baby's doctors and nurses before making any changes.

Do not make changes if you are pumping for multiple children (twins, triplets, or more).

Monitor the volume of your milk closely and have a clear plan to increase your pumping frequency or duration if your milk supply decreases.

Most mothers would much rather make more than their baby needs than to discover they are no longer making enough.